Why suicide risk may increase as we cope with COVID-19

The global pandemic caused by the coronavirus has upended every aspect of people's lives. More than three-quarters of Americans say they are living in relative isolation, avoiding small gatherings and public places. The communal hobbies and events that bring people joy and meaning — sports, movies, birthday parties, weddings — are now virtual affairs, if they happen at all. Meanwhile, the economic impact of COVID-19 is staggering: more than 16 million U.S. workers filed for unemployment in just three weeks.

Trauma and grief follow in COVID-19's wake as the disease destroys our collective sense of normalcy, kills thousands of Americans, and threatens to be deadly for a projected 60,000 people in the U.S. The loneliness, anxiety, and depression that, for some, accompany the pandemic has prompted concern about a brewing mental health crisis. Now, a new article published in JAMA Psychiatry suggests that COVID-19 may lead to increased risk of suicide. The suicide rate, which is 14.2 per 100,000 people, has been rising steadily for years.

Mark A. Reger, and Ian H. Stanley, both psychologists with VA Puget Sound Health Care System, and Thomas E. Joiner, a professor of psychology at Florida State University, argue that the "secondary consequences" of social distancing could put some at higher risk for dying by suicide.

The authors identify several factors that could lead to heightened risk, including social isolation, economic stress, difficulty receiving mental health treatment, less access to community and religious support, and higher firearm sales.

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Loneliness and social isolation are associated with suicidal thoughts and behaviors, and economic downturns have been linked to a higher suicide rate, according to the authors. Firearms are the most common method of suicide and gun purchases; federal background checks reached record highs last month. The authors also note that health care workers, who already have higher rates of suicide, "deserve support and prevention services" as they cope with anxiety about infection, the health of colleagues and loved ones, and overwhelmed hospitals.

While these trends are worrisome, they do not suggest that an increased suicide rate is an inevitable outcome of the pandemic.

"It is not a foregone conclusion that we will see increased suicide rates," Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, recently told MarketWatch, after President Trump emphasized the possibility at a recent town hall.

In fact, research has shown that following the Sept. 11 attacks, also a time of national crisis, regional suicide rates declined, potentially because people felt inclined to support one another and experienced stronger social bonds.

Julie Cerel, a suicide exposure researcher at the University of Kentucky who was not part of the JAMA Psychiatry article, said the pandemic presented a similar opportunity to strengthen relationships and help others in need, which can positively affect one's well-being.

"This isn't necessarily going to lead to a huge increase in suicides, but we need to be cognizant of what we can do in order to minimize that impact in people who are isolated and whose lives have been really negatively affected by...the pandemic," Cerel said.

The authors of the JAMA Psychiatry article note that certain measures could help reduce suicide risk. Those include increased screening for mental health crises, telemental health treatments for patients experiencing suicidal thoughts, and a focus on physical distance instead of social distance.

They urge people to maintain relationships and connections through telephone or video. That's particularly important for those who have numerous risk factors for suicide, like a family history of suicide, alcohol or substance misuse, physical illness, unwillingness to seek help, and easy access to lethal means.

The authors are optimistic about how key interventions can make a significant difference in terms of saving lives.

"Despite challenges, there are opportunities to improve suicide prevention efforts in this unique time," they write.

If you want to talk to someone or are experiencing suicidal thoughts, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 6:00 p.m. ET, or email [email protected]. Here is a list of international resources.